Healthcare is about providing critical services to people, but as any hospital chief financial officer or revenue cycle manager knows, providers that can’t pay the bills won’t be able to help any patients once the doors shut.
The problem: While healthcare profitability always has been a challenge – even prosperous hospitals typically run on margins of 3 percent or less – providers currently are contending with seismic shifts in healthcare reimbursement models as the industry transitions from fee-for-service to value-based payments that emphasize the quality of care. Further, many consumers are seeing premiums and deductibles rise to the point where they simply can’t afford to seek treatment – or pay for the treatment they receive.
American healthcare reimbursement is currently at an in-between stage. Some states are further along in the shift to value-based care/fee-for-value. Others are still predominately fee-for-service environments. That’s part of the challenge: Hospitals and health systems having to span two different worlds.”
Whichever world a healthcare provider is in, they need to get paid. Revenue is what powers the purchase of next-generation surgical equipment. It’s what supports those additional clinicians who staff the newly opened urgent-care clinic; it’s what enables the groundbreaking of a new asthma center in an area that is currently underserved.
Solution: Providers should leverage technology – specifically predictive analytics and automation – to achieve greater revenue cycle efficiency and better overall resource allocation. By leveraging a healthcare system’s own historical data, it’s possible to identify the normal revenue-cycle processes, model them, and then pinpoint the cases that exhibit anomalies. Technology can then make staff aware of the issues that truly require investigation, action, and resolution.